Pleural effusions are commonly seen in pancreatitis. They usually arise from the transdiaphragmatic transfer of exudative fluid during an episode of acute pancreatitis and resolve spontaneously. Rarely, in patients with chronic pancreatitis, pleural effusions can result from the development of a fistulous connection between the pancreas and pleural space; that is, a pancreaticopleural fistula. The authors present a case of a patient with a pancreaticopleural fistula and then review this rare but important entity.